Chest
Clinical InvestigationsPLEURAAccuracy of Pleural Puncture Sites*: A Prospective Comparison of Clinical Examination With Ultrasound
Section snippets
Subjects, Staff, and Location
The study took place in the respiratory unit of a tertiary teaching hospital. Over a 6-month period, all consecutive patients referred to the unit for the assessment of a presumed pleural effusion were considered for the study if a recent CXR was available and the patient was able to undergo the standard investigational procedure described below. Subjects gave informed consent. Patients receiving mechanical ventilation were not included.
Data Collection:
Age and gender were recorded as well as the presumed
Patients, Physicians, and Investigations Undertaken
Sixty-seven consecutive patients with pleural effusions of unknown origin participated in the study (Table 1). Malignancy was the most frequently suspected cause of effusion, but often no clear clinical suggestion was documented by the referring physicians. Every patient was reviewed by 2 to 6 physicians (mean 3.8); overall, 30 physicians assessed 255 cases for DPC (Table 2). In all cases, the physicians used chest percussion with or without other physical investigation techniques, mostly
Discussion
Clinical assessment with CXR and physical examination of the chest are the recommended standard methods utilized to locate a suitable site for DPC in patients with suspected pleural effusion.4 However, bedside chest ultrasonography has become increasingly popular for this purpose, although its impact on clinical practice had not yet been studied. In this prospective comparative study, we found bedside sonography to increase the number of patients amenable to DPC by 26% compared to clinical
ACKNOWLEDGMENT
Drs. M. Michot, W. Strobel, and E. Ullmer coordinated the study when Dr. Diacon was not available. Professors J.A. Schifferli and A.P. Perruchoud supported the study.
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